Health Professional Pandemic question

[greenberetTFS]

Originally Posted by Blitzzz

I'll be in chemo for the next 4 days. See you all when I get back.
Blitzzz

Good luck Blitzzz, My wife is starting her Rituxan(chemo) treatment in 2 days, it's for her RA. She gets it every 6 months on a two week interval. Hope they can keep it in remission for you also.................

GB TFS

[frostfire]

Originally Posted by doctom54

Physicians, nurses and other health care workers use PPEs and do their jobs. There is a risk but it is accepted as part of the profession.

Doing ER/ED assignment this summer. I've pretty much made peace with the fact that ER staff serves additional purpose as canaries in the mine. I'm not just referring to pandemic flu, but bioterrorism as well. My strategy would simply be maintaining my immune system at max via healthy diet, exercise, and vitamins/supplements, carrying OH-based hand sanitizer and moisturizer, using proper PPE and following SOP to the letter, and turning off the faucet and opening the restroom door with paper towel or elbow. I'm sure you all have heard/read about more germs on faucet than toilet seat.

Still, I very much like the idea of screening febrile patients right off the bat. I'm formulating ways right now to suggest this to the power-that-be without coming across the wrong way.

Best wishes with chemo, Blitzzz. I echo the advise of avoiding group of people especially in an enclosed environment. I myself got kicked out of my summer lodging arrangement after the house manager found out about my ER assignment. His wife is also under treatment for cancer.

[olhamada]

Originally Posted by The Reaper

If there is no shortage, people are acquiring a single course or so per family member or less, and supplies are presently adequate, how is it "hoarding"?

It would seem to me that additional purchases of widely available antibiotics would merely spur the pharm companies to make more.

TR

Last week, in the middle of the front page, the WSJ had a world map showing the percentage of Tamiflu/Relenza that was available in each country for its given population. According to their data, we've got enough to cover 16% of our population.

Something to think about.

From a Public Health perspective, hoarding should be strongly discouraged. But when I'm thinking about my family, well that's a different story.

This bug's evidently quite mild. However, the CDC is now starting to worry about this Fall's influenza. They think it will be quite a bit more virulent.

I agree with you TR, I bet supplies of Tamiflu and Relenze multiply between now and this fall. Problem is many of these viruses are resistant. Two months ago JAMA reported last year's flu showed a 70% resistance.

[olhamada]

Originally Posted by Blitzzz

I'll be in chemo for the next 4 days. See you all when I get back.
Blitzzz

Good luck Blitzzz. Saying a prayer for you. PM/email me with your room# if you get a minute.

[Red Flag 1]

Originally Posted by olhamada

Last week, in the middle of the front page, the WSJ had a world map showing the percentage of Tamiflu/Relenza that was available in each country for its given population. According to their data, we've got enough to cover 16% of our population.

Something to think about.

From a Public Health perspective, hoarding should be strongly discouraged. But when I'm thinking about my family, well that's a different story.

This bug's evidently quite mild. However, the CDC is now starting to worry about this Fall's influenza. They think it will be quite a bit more virulent.

I agree with you TR, I bet supplies of Tamiflu and Relenze multiply between now and this fall. Problem is many of these viruses are resistant. Two months ago JAMA reported last year's flu showed a 70% resistance.

Sufficent supply for family works for me, hoarding does not..IMHO. This could be quite a money maker for a few drug companies; maybe.

The current administration now has the lever and time it needs to elbow it's way into national health care. Ford tried it in 1976 in terms of flu shots only, not a very good outcome. There is potential here for this to become a solid political path to government run health care, a brick in the wall at least. I can see this administration dictating who makes what drug available for which patients.......I pray I am wrong! I am worried about the fall season.

My $.02.

Blitzz, I wish you the best with you're chemo! Prayers out!!!!

RF 1

[temsmedic]

A large number of the 1918 Pandemic fatalities died of bacterial pneumonia, after their lungs were damaged by influenza and the cytokine storm. It would be reasonable to consider the PPV23 [pneumococcal] vaccine as part of our pre-pandemic preparation.



http://ecdc.europa.eu/documents/pdf/PPV23_18_Jan.pdf

7. FUTURE PERSPECTIVES
Use of pneumococcal vaccines to reduce morbidity and mortality
from bacterial pneumonia in an influenza pandemic
Bacterial pneumonia is an important complication of seasonal and pandemic influenza and
during previous pandemics, secondary bacterial pneumonia has been an important cause of
morbidity and mortality. S. pneumoniae superinfection complicates many cases of influenza
and some bacterial pneumonia caused by S. pneumoniae can be prevented by immunisation47.
Issues related to the role of pneumococcal vaccines in pandemic influenza preparedness
activities may include: logistics of mass vaccination with PPV23 during a pandemic; vaccine
supply; shelf life; and need for cold storage. Nevertheless, increasing the current use of
pneumococcal vaccines among the age groups for which it is universally recommended (i.e.
persons aged under two years (PCV7) and those aged 65 and older (PPV23)) could reduce
the burden of pneumococcal disease and can also be expected to benefit persons susceptible
to influenza.

[shr7]

Mugwump -

I think we are in agreement over the statins. Those much smarter than me will say that they may help, and those much smarter than me that say they do not. I have been reading with interest the ongoing argument in Chest regarding this issue. I do believe that starting a statin would not be my first step if pandemic flu broke out, however, but I will keep my eye peeled for more data on this as time goes on.

I also completely agree with your "Prophylactic use of anti-virals by practicing medical professionals during an ongoing, virulent pandemic." Regardless of what the CDC says (and even they include certain health care professionals in their recommendations), I completely agree with you about it being a different situation than average Joe poppin' pills.

I also agree it probably won't matter soon. Articles from years ago all spoke how Tamiflu resistance was very uncommon and unlikely to be a problem, now look what we have, nearly 100% resistance in Type A influenza (up from 12% last year).

Also, I was under the impression doses for antivirals of all origins were the same. For Tamiflu, 75mg daily for prophylaxis and 75mg twice daily for treatment. Unless you are speaking about "double-doses" for treatment, I am not aware of any other reason to give one person twice daily for prophylaxis instead of two people once daily, doubling your coverage.

As for the probenecid, I agree that could be a way to extend our supply of Tamiflu. It was used successfully in the past as a way to extend penicillin supplies. Or course, not a benign drug, but worthwhile to look at. Studies are starting to come out looking at the kinetics of Tamiflu when used in combination with probenecid. One is linked below:

http://aac.asm.org/cgi/reprint/AAC.00047-08v1

I would say we do not know enough about the kinetics at this time to know an optimal dosing strategy for these medications when used in combination, so I would not feel comfortable if a pandemic were to hit tomorrow taking 1/2 doses of Tamiflu with probenecid, until I knew what regimen would be effective.

As for grapefruit juice or any other hepatic oxidase (CYP450) inhibitors, they would unlikely have any effect on Tamiflu (oseltamivir) concentrations. Tamiflu is a prodrug, oseltamivir phosphate, which is converted by hepatic esterases to its active metabolite, oseltamivir carboxylate, which is then excreted out through the kidney. It is not a CYP450 metabolite and would not react to any medications given that inhibit CYP450 enzymes. Probenecid works through inhibition of the renal excretion of oseltamivir carboxylate, so through a different mechanism.


TR -
You bring up a good point about increasing demand for these medications. I don't want to answer prematurely without getting all my facts correct, so I will get back to you with my personal thoughts on the subject.

SR

[greenberetTFS]

IRONY AT IT’S BEST.......

2,500 people get the Swine Flu and everybody wants to wear a mask.
Six million people have AIDS and no one wants to wear a condom....................

GB TFS